Postbariatric Surgery Deaths, Which Fall Under the Jurisdiction of the Coroner

Abstract

Obesity has attained epidemic proportions in the United States, with more than 50% of adults classified as overweight or obese. If untreated, morbidly obese patients have a 1 in 7 chance of reaching normal life expectancy. The surgical treatment of obesity has emerged as the most effective treatment modality in long-term weight control and has become increasingly popular, with attendant postoperative complications and death. We performed a cross-sectional, coroner based, 2-year retrospective review of archival case records for decedents who died following bariatric surgery for the treatment of obesity to identify underlying causes of death and forensic characteristics of this cohort. Fifteen (0.5%) out of 3097 archival cases died following bariatric surgery, with approximately 73% of decedents dying within 6 months of surgery. The underlying causes of death in 80% of decedents were natural comorbidities of obesity, with cardiovascular diseases (33%) being the most frequent causes of death, followed by gastrointestinal diseases (20%), acute pulmonary thromboembolism (13%), and acute bacterial pneumonia (13%). The majority of decedents were white females who remained morbidly obese after bariatric surgery. Only 2 decedents died of direct inadvertent/accidental surgical complications.

Benchmarking Best Practices in Weight Loss Surgery

“…By the year 2015, that number is expected to reach an estimated 700 million [21]. Without intervention, only 1 in 7 obese patients will reach their full life expectancy [22,23]. …”

Bariatric Surgery: A Review of the Available Procedures and Complications for the Emergency Physician

“…Early postoperative complications include wound infections, wound dehiscence, leaks from the staple/suture anastamosis line, acute gastrointestinal obstruction, stomal stenosis, stomal/marginal ulcers, acute upper gastrointestinal bleeding, and dumping syndrome. Thromboembolic complications including pulmonary embolus and deep venous thrombosis occur in up to 10% of bariatric procedure patients (2,7).…”

“…It is estimated that 50% of Americans are overweight and that 1 in 5 are obese (1,2). The prevalence of obesity has tripled in the last three decades.…”

Feedback control of retrograde peristalsis using Neural Gastric Electrical Stimulation

“…Various disorders and conditions have been related to obesity, many of which are life-threatening [22]. NGES is a promising technique to treat obesity that could provide reliable long term results without suffering from the side effects associated with pharmacotherapy [23] or from the postoperative complications related to bariatric surgery [24,25]. Invoked and appropriately controlled retrograde peristalsis could be an important avenue for delaying gastric emptying and thus indirectly controlling satiety and food intake [26].…”